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History of preventive medecine: three phases of prevention in the western world HISTORY OF PREVENTIVE MEDECINE: THREE PHASES OF PREVENTION IN THE WESTERN WORLD
Historically, the prevention of disease has been the greatest and most important contribution to the health of the western world but simply to think of preventive medicine in terms of public health is far too narrow a perspective today.
The first phase of preventive medicine was indeed this rather authoritarian, organizational public health approach. It was based on the need to control infectious illnesses using environmental control imposed on people 'for the good of the community'. In this way clean water became the norm, sewers took away waste, food was inspected and its quality improved, and pest-infested slums were cleared. All of this did wonders for life expectancy. In white women in the US life expectancy increased from 40 years in 1855 to 55 years in 1920. Almost all of this increased life-span came about because of the reduction in infant death rates. Little, if any, change was made to the longevity of those who survived to middle life. In 1855 a 45-year-old American could expect to live another 24.6 years and in 1910 the figure was 25.5 years. Hardly a stunning advance!
As well as the giant steps forward being taken in sanitation, immunology began to blossom as a medical growth area and diphtheria, whooping cough, measles, polio and smallpox came under control.
Initially this era of prevention was characterized by individual heroism and leadership together with more health laws. The amount of voluntary action on the part of the public was minimal. Certainly immunization required the individual to turn up to be vaccinated but otherwise preventive medicine was a 'painless' procedure that was done to an individual.
The second phase in the development of preventive medicine actually started before the ending of the first and came with the discovery of anaesthesia and antiseptics. Phase two, then, was that made possible by increasing technology and financial investment. Undoubtedly the greatest triggers to the growth of medical knowledge were the two world wars in this century. Knowledge of anaesthesia and antiseptics lay dormant until the vast number of operations done in World War I made advances necessary on an unprecedented scale. By World War II sulpha drugs (1935) and penicillin (1940) had been developed and the modern pharmaceutical industry as we know it was born. This opened up for the first time the idea of massive capital investment in the health field. In the first phase of the growth of prevention, public health measures were seen as a way of improving the nation's strength and wealth and a way of maintaining a vigorous population which could produce goods and services in a fast-growing capitalist society. In the second phase the goal of a healthy population became obscured as the health industry took on a life of its own. Today, doctors make the financial decisions which control this vast industry and often they make them in splendid isolation-thinking only in the context of their relationship with an individual patient.
This has led to the enormous sickness industry we now see. Yet for all this so-called advance and expenditure the life-span of a five-year-old has increased by only 2.9 years since 1940. The limits to this kind of medicine are all too apparent. It has been calculated that the elimination of all cancers of the cervix, for example, as a cause of death would add only three-tenths of a year of life to that which the average woman currently enjoys. If after fifty years of screening and gynecological examinations her fate is that of many old people-to live alone in relative poverty-just how valuable are these extra three and a half months to her anyway?
The third phase of preventive medicine is now with us, as we start to consider health in the context of our environment-in short, man in his ecological setting. The excitement and drama of the last forty years' growth in medicine is beginning to wear thin and people are beginning to look at prevention in personal terms-as something they actually have a hand in and for which they have a responsibility.
It has been calculated that more disease, disability and premature death could be prevented by eliminating alcohol and tobacco abuse and by restricting the use of cars than by any foreseeable increase in expenditure on health. But it is not true that individuals are solely to blame now that doctors can do so little to help. The medical profession can't shrug its shoulders and say, 'Look what we've done for you, you should be grateful.' It is no new concept that the choice as to how an individual uses his or her life rests with him or her. But the fact that there is a personal responsibility for health does not absolve doctors, nurses, politicians or administrators from responsibility, nor does it free them to ignore prevention on the grounds that it is something the individual ought to be doing for him or herself.
Phase three of the story of prevention involves the individual taking the dominant role-and this is what this book is about: personal prevention.
*9/72/5*
GENERAL HEALTH
«No Prescription Pharmacy»
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